Endoscopic Hand Suturing Success and Adverse Event Rates

Colorectal

Douglas K. Rex, MD, MASGE reviewing Ayoub M, et al. Endoscopy. 2026 Jul 7.

SutuArt (Olympus Corp, Tokyo, Japan) is an endoscopic hand suturing (EHS) system available in Europe and Japan but not in the United States that allows through-the-scope suturing. In a registry study, researchers collected all EHS procedures performed at 14 centers across Europe. Between February 2023 and January 2026, 338 EHS procedures were performed on defect closures related to endoscopic procedures, including 240 endoscopic submucosal dissections (ESDs), 32 endoscopic intermuscular dissections, 41 gastric peroral endoscopic myotomies, and other miscellaneous procedures.

The median defect size was 35 mm, median suturing time was 25 minutes, and the technical success rate, defined as complete closure with EHS alone, was 96.2%. Technical success was >90% for all defect types and locations except the duodenum, where 5 of 6 ESD defects (83%) were successfully closed.

The findings also show 97.9% in-hospital clinical success, defined as the absence of postinterventional complications during hospitalization and no complications attributable to the index procedure. Five patients (1.5%) experienced procedure-related adverse events, including incomplete fistula closure, mild post-ESD bleeding, secondary perforation, reopening of the defect site with bleeding, and 1 severe delayed bleeding episode after discharge due to suture dehiscence.

Comment:

In the U.S., the Overstitch device (Boston Scientific, Marlborough, Mass) is used for full-thickness endoscopic suturing. The SutuArt and Overstitch EHS systems have never been compared for speed, suturing, or efficacy.

Although the SutuArt needle holder is passed through the working channel, the curved needle cannot traverse the channel and must be loaded outside the patient, necessitating scope withdrawal before insertion. The needle is secured with the needle holder outside the patient and passed into the patient through an overtube or protective hood located at the tip of the endoscope.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, MASGE

Bio and Disclosures

Citation(s):

Ayoub M, Kizilaslan EZ, Nagl S, et al. Technical and clinical success of endoscopic hand-suturing: a European multicenter study. Endoscopy. 2026 Jul 7. (Epub ahead of print) (https://doi.org/10.1055/a-2909-3681)